Male Infertility: Causes and Treatment Options

Male infertility is related to testicular disease, hormone deficiencies and structural problems with the male reproductive organs, as well as exposure to certain chemicals, chemotherapy agents or radiation treatment for cancer. Substances such as alcohol, marijuana and other illegal drugs, anabolic steroids and some herbal remedies – especially those that affect hormone levels – have been linked to low sperm count and/or abnormal sperm movement or shape. Certain prescription medications, including those for ulcers, hypertension, epilepsy and depression also can contribute to infertility. Nicotine has been shown to have some negative effect on testosterone production, which adversely affects sperm production and development. Also, certain illnesses that include high fever can temporarily affect sperm count and motility. The common causes of male-factor infertility are:

Infections

Hormonal Imbalances

Sexual Dysfunction

Sperm Quantity and Quality

Blockages and Other Anatomical Problems

Varicocele

Immune System Disorders

Hypospadias

Read the descriptions below to learn more about the causes of infertility.

Infections

Infections in the male reproductive organs can be caused by sexually transmitted diseases, mumps contracted as an adult and bacteria. Unless noticeable symptoms occur, these infections can go untreated. Severe infection can cause scarring, blockages and/or other damage to the male reproductive organs.

Treatment Options for Infection

Medications – antibiotics can be effective in treating infections of the male reproductive disorders; however, it is important to treat them early to avoid permanent damage.

Surgery – may be required in cases where infection has resulted in scarring or blockages that affect sperm production and/or ejaculation.

Hormonal Imbalances

Problems with the hypothalamus and pituitary glands – glands in the brain that produce reproductive hormones – can affect sperm production and sexual function. Thyroid problems also can lead to low levels of testosterone, follicle stimulating hormone (FSH) and luteinizing hormone (LH) required for sperm production.

Treatment Options for Hormone Imbalances

Medication – may be prescribed for certain hormonal imbalances. Human chorionic gonadotropin (HCG) supports the production of testosterone in the male reproductive organs. Clomiphene citrate helps the hypothalamus and pituitary glands produce the chemical that stimulates LH and FSH production. These in turn regulate testosterone production and improve sperm production.

Sexual Dysfunction

Male sexual dysfunction can be related to medical conditions and psychological issues including stress. In some cases, age plays a part. Although age-related changes in male fertility are not as pronounced as those in the female, sex drive, sexual function and the ability to conceive can be diminished by changes in the testes, the quality of sperm and hormone-related problems. Still, men continue to produce sperm and can conceive at ages well beyond those at which women experience menopause and the end of fertility.

Many males produce plentiful, high quality sperm but they experience problems ejaculating. With premature and delayed ejaculation, timing prevents orgasm and the release of sperm into the vagina during intercourse. Retrograde ejaculation is when semen is released backwards, into the bladder, as a result of trauma, nerve damage or other problems from prostate or lower back surgery, birth defects and diseases including diabetes and multiple sclerosis. Retrograde ejaculation also is linked to certain prescription drugs, including those for depression and high blood pressure.

Treatment Options for Sexual Dysfunction

Medication – may be available to address sexual dysfunction depending on the nature of the problem and the cause. Fertility medications can be prescribed to restore hormonal balance, increase the sex drive, restore sexual function or improve performance. Oral medications may be effective in improving retrograde ejaculation by helping the bladder neck close during ejaculation.

Surgery – recommended in cases where sexual dysfunction results from scarring, blockages or growths that can be removed surgically.

Insemination – in cases involving retrograde ejaculation, sperm may be found in the urine. If healthy sperm can be extracted, insemination is an option. In cases where timing is the problem, collection of sperm through masturbation and insemination may be recommended.

Therapy – “performance anxiety” that contributes to several forms of sexual dysfunction can be addressed with therapy directed at the cause and/or focused on techniques to reduce stress and restore sexual confidence and function.

Sperm Quantity and Quality

Although only one sperm is needed for conception, millions are released during intercourse to increase the chance of pregnancy. A fertile male ejaculates at least 2 milliliters of semen with the right consistency to transport at least 40 million sperm toward the waiting egg(s). Of these, at least 50% should be moving vigorously through the liquid, 2% must be moving forward and at least 4% should have a normal shape – an elliptical head and tail to provide the thrust they need.

Poor sperm count and quality are indicators of male-related infertility. If a semen sample also includes too many white blood cells, bacteria, sexually transmitted diseases or infection also may be contributing to the problem. Males exposed to DES (diethylstilbestrol) a synthetic hormome taken by pregnant women in the 1960s and 1970s, also may have anatomical abnormalities and problems with sperm count, movement and shape.

Treatment Options for Poor Sperm Count or Quality

Surgery – microsurgical epididymal sperm aspiration (MESA and TESA)are surgical techniques recommended when there are few or no sperm in the ejaculate as a result of vasectomy, congenital absence of the vas deferns or epididymis, prior failed surgery or epididymal scarring from infection. Tissue is collected from the testes and processed in the laboratory to remove healthy sperm for use with intracytoplasmic sperm injection (ICSI). Used with in vitro fertilization (IVF), ICSI involves injection of a single sperm into the core of an egg.

Blockages and Other Anatomical Problems

Structural defects in reproductive organs can stop the passage of sperm from the testis, where they develop, to the ejaculatory duct. Blockages result from birth defects or scar tissue formed after infection or surgery. Vasectomy, an elective sterilization procedure, prevents the flow of sperm by cutting and tying off the ends of the vas deferens, a tube that carries sperm from the epididymis to the ejaculatory duct.

Some experts believe that blocked and enlarged veins around the testes, called varicoceles, cause infertility by raising the temperature in the scrotum and decreasing sperm production. However, others discount the effect of varicoceles because they also are found in fertile men.

Treatment Options for Blockages and Other Anatomical Problems

Surgery – vasectomy reversal (vasovasostomy) is a microsurgical technique that involves removal of scarred sections and reconnection of the vas deferns so sperm can travel out of the epididymis and into the ejaculate. Epididymal repair (vasoepididymostomy) may be an option if vasovasostomy won’t work because there are no sperm present in the vas deferns. This surgery is used to remove obstructions in the epididymis caused by pressure from testicular fluids, leakage of sperm into surrounding tissues after a vasectomy, infections, trauma or congenital defects. Vasoepididymostomy restores the flow of semen by stitching the inner and outer layers of the vas directly to the epididymis and its inner tubule, at a point above an obstruction.

Varicocele

A varicocele is an abnormally swollen (varicose) vein that diminishes or blocks blood flow around the testes. Because they raise the temperature of the scrotum, varicoceles have been linked to poor sperm production and quality. However, varicoceles also are present in fertile men, causing debate over the effectiveness of treatment.

Treatment Options for Varicoceles

Surgery – recommended by some for varicocele repair, a microsurgical technique is used to tie off the vein to eliminate the swelling.

Immune System Disorders

The production of sperm doesn’t occur until a male reaches puberty. Normal function can be interrupted by surgical sterilization (vasectomy), trauma or infection. In some cases where sperm are first or once again produced, the male’s immune system identifies them as foreign substances and creates antisperm antibodies. The antibodies are designed to destroy the invading cells by attaching themselves to the sperm, preventing their passage or fertilization.

Treatment Options for Immune System Disorders

Medication – steroids may be prescribed to destroy the antibodies.

Sperm washing – collected through masturbation, sperm is washed in the laboratory to remove antibodies. The options are to inject them directly into the female during Intrauterine Insemination (IUI) or into a laboratory dish containing eggs retrieved from the female during in vitro fertilization (IVF).

Hypospadias

As a result of this congenital condition, the opening of the urethra is not located at the end of the penis and semen can’t be ejaculated into the vagina during intercourse.

Treatment Options for Hypospadias

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Insemination – semen is collected through masturbation, washed of impurities and injected directly into the uterus during intrauterine insemination.

Surgery – permanent correction of the problem with surgery may be an option.

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